Bullous pemphigoid

Diagnosis: Bullous pemphigoid

Bullous pemphigoid

Clinical Presentation

Bullous pemphigoid

Clinical History

Submitted by Ellie Goulding MD. Originally posted January 23, 2017.

Treatment

See case discussion.

Differential Diagnosis

• Pemphigus vulgaris • Linear IgA bullous dermatosis • Dermatitis herpetiformis • Epidermolysis bullosa acquisita • Bullous drug eruption • Erythema multiforme • Bullous lupus erythematosus

Key Learnings

• Most common autoimmune blistering disease — IgG against BP180 and BP230 (hemidesmosomes) • Subepidermal blister — tense bullae that are less fragile than pemphigus • Nikolsky sign is negative (positive in pemphigus) • DIF shows linear IgG and C3 at the dermal-epidermal junction • Salt-split skin: antibodies bind to the epidermal (roof) side • Drug-induced BP: DPP-4 inhibitors (gliptins), PD-1 inhibitors, diuretics • Often occurs in elderly patients (>60 years)

Tags: bullous, pemphigoid, ellie goulding md